布托啡诺经鼻给药超前镇痛在日间手术模式下LIHR术后镇痛中的应用

Effects of Preemptive Intranasal Butorphanol Analgesia on Postoperative Analgesia in Laparoscopic Inguinal Hernia Repair under Ambulatory Surgery Model

为评价不同剂量布托啡诺经鼻给药超前镇痛用于日间手术模式下腹腔镜腹股沟疝修补(LIHR)术后镇痛的效果,选择日间手术模式下全麻LIHR患者230例,随机分为5组(n=46):布托啡诺0.005mg/kg组(B1组)、布托啡诺0.01mg/kg组(B2组)、布托啡诺0.02mg/kg组(B3组)及布托啡诺0.03mg/kg组(B4组)及对照组(C组)。在麻醉诱导前10min,B1、B2、B3及B4组分别以各自剂量经过鼻腔滴入布托啡诺;C组以等容量生理盐水模拟。计算麻醉苏醒时间、拔管时间、在PACU内停留时间。分别在术后1h、4h、6h、8h、10h、12h及离院(T1~T7)时对患者进行术后镇痛及布氏舒适度评分,统计术后镇痛期间恶心呕吐、术后谵妄、头晕及嗜睡等不良反应的发病率及麻醉后离院评分(PADS)和未按时出院率。结果布托啡诺0.01mg/kg^0.02mg/kg经鼻给药超前镇痛可安全有效地应用于日间手术模式下腹腔镜腹股沟疝修补术后镇痛,且术后恶心、呕吐、术后谵妄等不良反应发病率低,无苏醒延迟。

To evaluate the effects of preemptive analgesia by nasal butorphanol administration in different doses on postoperative analgesia for laparoscopic inguinal hernia repair(LIHR)under ambulatory surgery model,a total of 230 patients undergoing ambulatory LIHR surgery with general anesthesia were randomly(by the order of hospitalized)divided into five groups:0.005mg/kg of butorphanol(B1 group);0.01 mg/kg of butorphanol(B2 group);0.02mg/kg of butorphanol(B3 group);0.03mg/kg of butorphanol(B4 group)and control group(C group).Different doses of butorphanol were intranasal administrated at 10 min before general anesthesia induction.As the control group,same volumes of normal saline were administrated in C group patients.The total surgery time,anesthesia recovery time,anesthesia extubation time,PACU stay duration,the visual analogue scale(VAS)and Bruggrmann comfort scale(BCS)were evaluated at 7 time points(postoperative 1h,4h,8h,10h,12h and discharged);the morbidity of adverse effects as postoperative nausea and vomiting(PONV),postoperative delirium(POD),dizziness,drowsiness,and post\|anesthesia discharge score(PADS)and prolonged time of discharge were recorded and analyzed.Preemptive analgesia with a safe dose of 0.01 mg/kg^0.02mg/kg butorphanol intranasal administration benefits postoperative analgesia in patients undergoing ambulatory LIHR surgery for reducing the morbidity of PONV,POD without anesthesia recovery delay.